Organization
JULIE S. DIDAT O.D P.S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE MATTINGLY (OFFICE MANAGER)
(812) 738-1707
Entity
Organization
Contact information
Practice address
2127 EDSEL LN NW, CORYDON, IN 47112-2030
(812) 738-1707
(812) 738-9054
Mailing address
2127 EDSEL LN NW, CORYDON, IN 47112-2030
(812) 738-1707
(812) 738-9054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100116680B
—
IN
Enumeration date
01/19/2012
Last updated
01/19/2012
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